This survey is for women ages 18-44 and fathers of newborns/children up to 18 months. 
Lorain County Public Health is conducting this assessment to gain valuable insights into your overall health and well-being. Your responses will help us better understand the health needs and concerns of our community, enabling us to improve our programs and services to support you effectively.

If you choose, you can provide your name, phone number, and email, and you will be entered into a drawing to win a $100 gift card. Ten gift cards will be raffled. 

Assessment sections include:
  • Demographics
  • Substance use
  • Mental health
  • Healthy eating and active living
  • Reproductive health
    Social
  • Access to care
  • Patient communication
  • Living situation
  • Education
  • Transportation/legal.
Thank you for your participation!
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Lorain County Public Health. Report Abuse